Richard Scheffler & Stephen Shortell – The Commonwealth Fund (4/21/2023)

Abstract

• Issue: A public option is a government-established health insurance plan designed to inject more competition into the market and improve coverage affordability over time. Despite widespread support, little progress has been made at the federal or state level toward creating such a plan. We propose a public option plan for California, Golden Choice, that would be based on the state’s “delegated model” of health care under which provider organizations accept the financial risk for delivering health care services.
• Goals: To assess the proposed plan’s competitive impact on premiums in 19 markets in the Covered California health insurance marketplace.
• Methods: Regression models using Integrated Healthcare Association and related data to estimate premiums; qualitative interviews with health plan and medical group leaders.
• Key Findings and Conclusions: Golden Choice would have the lowest premiums in 14 of the 19 Covered California regions and save $243 million ($1,389 per year per projected enrollee) in one year. Similar results were found when assessing the impact of public-employee HMOs as well as L.A. Care, the only county-based public option. Plan and medical group leaders reported that under Golden Choice, they could provide high-quality care while operating with premiums of 5 percent to 10 percent less than current plans. Moreover, a successful public option based on the delegated risk model would not require regulatory changes or mandates.

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